Healthcare Provider Details

I. General information

NPI: 1912939059
Provider Name (Legal Business Name): JAMES DICKEY SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N WOODBINE RD
ST JOSEPH MO
64506
US

IV. Provider business mailing address

1802 N WOODBINE RD PO BOX 6423
ST JOSEPH MO
64506
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-5113
  • Fax: 816-232-0453
Mailing address:
  • Phone: 816-232-5113
  • Fax: 816-232-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006432
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: